Assessing post-radiotherapy handover notes from a family physician perspective.

BACKGROUND: Across our province, post-radiotherapy (rt) handover notes are sent to family physicians (fps) after rt. Based on previous fp feedback, we created a revised post-radiotherapy handover note with more information requested by fps. The purpose of this study was to determine whether the revised handover note improved the note as a communication aid. METHODS: Potential common and rare treatment side effects, oncologist contact information, and treatment intent were added to the revised handover note. Both versions were sent alongside a questionnaire to fps. Paired t-tests were carried out to compare satisfaction differences. RESULTS: There was a response rate of 37% for the questionnaires. Significantly greater clarity in the following categories was observed: responsibility for patient follow-up (mean score improvement of 1.2 on a 7-point Likert scale, p < 0.001), follow-up schedule (1.1, p < 0.001) as well as how and when to contact the oncologist (1.4, p = 0.001). Family physicians were also more content with how the institute transitioned care back to them (1.5, p = 0.012). Overall, fps were generally satisfied with the content of the revised post-rt handover note and noted improvement over the previous version. The frequency of investigations and institute supports initiated such as counselling services were suggested further additions. CONCLUSIONS: The inclusion of potential treatment side effects, oncologist contact information, treatment intent and a well-laid out follow-up schedule were essential information needed by fps for an effective post-rt completion note. With these additions, the revised post-rt handover note showed significant improvement.

e-Derma - a Novel Wireless Dermatoscopy System.

Cutaneous Melanoma (CM) is a malignant tumour, and is one of the most rapidly growing cancers. Discovering a melanoma in the early stages of the disease is extremely difficult and, as such, only an invasive disease stage can be identified easily with the naked eye. Dermatoscopy is a diagnostic method intended to maximise early detection of CM performed by the dermatoscopy system. To address the limitations of existing systems a novel, wireless digital dermatoscopy system is presented for providing high-resolution images. It integrates a wire-free camera operation and offers a safe transfer of captured images to the computer. The working process of available dermatoscopy systems was studied, which are the most commonly used in everyday dermatology practice. Some findings, like operability, image quality, scalability, user-friendliness, and safeness, were used for the development of an e-Derma dermatoscopy system. An assessment method was performed by a group of dermatoscopy trained dermatologists to evaluate the quality of the testing images. Finally, a laboratory evaluation of images in regard to different parameters like sharpness, colour representation and illumination was performed with the side-by-side comparison of images of available dermatoscopy systems. e-Derma is a novel dermatoscopy system, which eliminates some limitations of existing systems and provides high-quality images. A novel low-budget highly capable dermatoscopy system is presented. The integrated wireless image transfer technology eliminates the movement limitations of a therapist. The image resolution is not limited by the integrated camera; it is easily upgradable with a wide range of on market alternative or improved camera models.

Contribution of angiogenic factors in a rat model of pre-eclampsia.

BACKGROUND/AIMS: Pre-eclampsia is a disorder that results in significant feto-maternal complications with yet no definitive pharmacologic intervention. One postulated etiologic mechanism is an imbalance between circulating pro-angiogenic and anti-angiogenic factors. We investigated these factors sequentially throughout pregnancy (19-21 days) in our rat model of pre-eclampsia, which involves the imposition of excessive volume expansion. METHODS: We evaluated the status of the pro-angiogenic and anti-angiogenic factors at the following time points: 3-5, 7-10 and 17-20 days of gestation. RESULTS: We have previously determined that the urinary excretion of the circulating bufodienolide, marinobufagenin, is elevated at the 3- to 5-day time period, prior to the advent of hypertension and proteinuria. At 3-5 days of pregnancy, there was no evidence of angiogenic imbalance in the normal pregnant (NP) and 'pre-eclamptic' (PDS) rats. At the 7- to 10-day time point, plasma PlGF was greater in the NP rats than in the PDS group (p < 0.05). The plasma sFlt-1/PlGF ratio in the PDS animals was greater than that in the NP rats (p < 0.05). The placental sFlt-1 and sFlt-1/PlGF ratio were greater in the PDS rats than in NP rats (p < 0.05). These changes were also present at the 17- to 20-day time point in both plasma and placenta. The administration of resibufogenin, an antagonist of marinobufagenin, early in pregnancy, prevented angiogenic imbalance. CONCLUSION: We conclude that angiogenic imbalance plays a role in the pathogenesis of pre-eclampsia in this rat model. Furthermore, the earliest event in the pathogenetic sequence appears to be the secretion and elaboration of marinobufagenin.

Marinobufagenin inhibits proliferation and migration of cytotrophoblast and CHO cells.

Marinobufagenin (MBG) is an endogenous mammalian cardiotonic steroid that is involved in the inhibition of the sodium pump Na(+)/K(+)-ATPase. Increased plasma levels of MBG have been reported in patients with volume expansion-mediated hypertension and preeclampsia. We have recently demonstrated that MBG impairs both the proliferation and growth factor-induced migration of human first trimester cytotrophoblast (CTB) cells, crucial for proper placental development. However, the intracellular signaling mechanisms regulating the MBG-induced impairment of CTB differentiation, migration and invasion are unknown. The human extravillous CTB cell line SGHPL-4 was utilized for this study. The phosphorylation of MAP kinase protein ERK1/2 was evaluated by Cellular Activation of Signaling ELISA (CASE) in control CTB cells and those treated with MBG. MBG at concentrations of 10 and 100nM inhibited CTB cell proliferation, migration and invasion (60%, 50% and 50%, respectively). MBG also caused a significant decrease in the phosphorylation of ERK1/2. In addition, MBG decreased proliferation, migration, and ERK1/2 activity in another motile cell line, CHO cells. Another sodium pump inhibitor, ouabain, similarly decreased proliferation and ERK1/2 activity in CTB and CHO cells. These data suggest that the changes observed in cell function may be mediated by inhibition of Na(+)/K(+)-ATPase. We demonstrate that the MBG-induced impairment of CTB cell proliferation, migration and invasion is associated with decreased ERK1/2 activity which may be mediated by inhibition of Na(+)/K(+)-ATPase.

Neuronal activity in the lateral cerebellum of the cat related to visual stimuli at rest, visually guided step modification, and saccadic eye movements.

1. The discharge patterns of 166 lateral cerebellar neurones were studied in cats at rest and during visually guided stepping on a horizontal circular ladder. A hundred and twelve cells were tested against one or both of two visual stimuli: a brief full-field flash of light delivered during eating or rest, and a rung which moved up as the cat approached. Forty-five cells (40%) gave a short latency response to one or both of these stimuli. These visually responsive neurones were found in hemispheral cortex (rather than paravermal) and the lateral cerebellar nucleus (rather than nucleus interpositus). 2. Thirty-seven cells (of 103 tested, 36%) responded to flash. The cortical visual response (mean onset latency 38 ms) was usually an increase in Purkinje cell discharge rate, of around 50 impulses s-1 and representing 1 or 2 additional spikes per trial (1.6 on average). The nuclear response to flash (mean onset latency 27 ms) was usually an increased discharge rate which was shorter lived and converted rapidly to a depression of discharge or return to control levels, so that there were on average only an additional 0.6 spikes per trial. A straightforward explanation of the difference between the cortical and nuclear response would be that the increased inhibitory Purkinje cell output cuts short the nuclear response. 3. A higher proportion of cells responded to rung movement, sixteen of twenty-five tested (64%). Again most responded with increased discharge, which had longer latency than the flash response (first change in dentate output ca 60 ms after start of movement) and longer duration. Peak frequency changes were twice the size of those in response to flash, at 100 impulses s-1 on average and additional spikes per trial were correspondingly 3-4 times higher. Both cortical and nuclear responses were context dependent, being larger when the rung moved when the cat was closer than further away. 4. A quarter of cells (20 of 84 tested, 24%) modulated their activity in advance of saccades, increasing their discharge rate. Four-fifths of these were non-reciprocally directionally selective. Saccade-related neurones were usually susceptible to other influences, i.e. their activity was not wholly explicable in terms of saccade parameters. 5. Substantial numbers of visually responsive neurones also discharged in relation to stepping movements while other visually responsive neurones discharged in advance of saccadic eye movements. And more than half the cells tested were active in relation both to eye movements and to stepping movements. These combinations of properties qualify even individual cerebellar neurones to participate in the co-ordination of visually guided eye and limb movements.

In vitro assessment of asbestos fibers genotoxicity.

This study was carried out in order to assess the genotoxic effect of in vitro exposure to commercial chrysotile asbestos. V 79 cell line, known as a well-established cellular model, was used for detection of asbestos genotoxic potency. Conventional structural chromosomal aberration analysis and sister chromatid exchange (SCE) method were both used for asbestos genotoxicity assessment. Within the experimental protocol applied, V 79 cells were treated with asbestos in concentrations of 100 and 200 micrograms/ml F-10 (HAM) media during 90 days, respectively. Analysis of changes in chromosome structure as well as of cell ploidy was performed each tenth day of the experimental course, consecutively. Two hundred well spread metaphases were taken into account for chromosomal aberration analysis. Frequency of sister chromatid exchanges was observed in 50 cells per sample. The results of cytogenetic tests revealed structural chromosomal damages, SCE-elevation and changes in cell ploidy. Cytogenetic effect of asbestos obviously depended on the dose applied and on the period of incubation. The results of this study suggest that significant cytogenetic changes occurring after asbestos treatment might directly or indirectly be the part of the biological events responsible for eliciting asbestos-induced carcinogenesis.

Chromosome aberrations induced in human lymphocytes by U-235 fission neutrons. Part III: Evaluation of the effect of the induced alpha and beta activity on the chromosomal aberration yield.

AIM: Further experiments were performed to explain a difference in chromosomal aberration yield found between samples cultivated immediately after fission neutron irradiation and samples which were cultivated with 96 h delay after irradiation. MATERIAL AND METHOD: Human peripheral blood samples were irradiated in mixed fission neutron/gamma field (1800 s) and biological effect assessed in the mean of analysis of unstable chromosome aberrations with a time delay in culturing cells of 12, 24, 48, and 96 h. Additional measurements were performed on irradiated and blank blood samples with the aim to detect any increase in alpha and beta activity after fission neutron irradiation. No difference was found. Results were compared to theoretically calculated values of the alpha and beta activity released from natural radioactive isotopes. RESULT AND CONCLUSION: As a conclusion it is shown that in our experimental conditions the secondary effects resulting from nuclear transformations of natural or induced radioactive isotopes, recoil reactions and accompanying alpha, beta, and gamma radiation are not the reason for the increase observed in chromosomal aberration yield in blood samples cultured with a time delay of at least 24 hours.

Work environment influence on cytostatics-induced genotoxicity in oncologic nurses.

The aim of the study was to point out the influence of workplace conditions on chromosomal damage incidence in nurses handling cytostatics. The study comprised two groups of 17 oncologic nurses each and the same number of matched controls. Sister chromatid exchange method (SCE) was used for genotoxicity assessment. In the group of nurses provided with a safe working environment, the SCE-frequency was insignificantly increased when compared to the controls (p > 0.8), although wide SCE-ranges were obtained. By contrast, in the group of nurses provided with neither such an environment nor with the appropriate personal protective equipment, the SCE-frequency was significantly higher, not only compared to the controls (p < 0.001), but also to the first test group (p < 0.001).

Potential genotoxic risk related to simultaneous exposure to radionuclides and cytostatics.

The aim of the study was to evaluate the genotoxic risk to medical personnel concurrently exposed to ionizing radiation and antineoplastics, using changes in their lymphocyte cell genome as a bioindicator. The study comprised 12 female nurses employed in the nuclear medicine hospital department and an equal number of matched controls. For each examinee, both conventional structural chromosomal aberration analysis and sister chromatid exchange test (SCE) were carried out. According to Student's t-test, neither the incidence of structural chromosomal aberrations (p > 0.6) nor the mean SCE-frequency rate (p > 0.3) were significantly increased among the exposed subjects. Nevertheless, in those exposed, irreparable chromosomal damages and wide SCE-ranges were observed. Such findings suggest the possibility of genotoxic implications of concurrent occupational exposure to ionizing radiation and antineoplastic drugs.

Evaluation of serial application of capillaroscopy, photoplethysmography, and dermothermometry in diagnosis and prevention of radiolesions of peripheral microvessels.

This study was performed with the aim of evaluating the justifiability of serial application of nailfold capillaroscopy, digital dermothermometry and digital photoplethysmography in the diagnosis of vascular radiolesions in subjects occupationally exposed to ionizing radiation. Thirty-eight exposed examinees, as well as 30 control persons, were included in the study. In order to establish the condition of the peripheral blood flow, each subject was examined by all the three methods. The results of this work and their statistical evaluation showed the nailfold capillaroscopy and digital dermothermometry to be the most suitable combination of methods for detection of initial changes on the smallest skin blood vessels, subsequent to skin irradiation, while the use of photoplethysmography should be limited to such cases where alterations of digital arterioles are expected.

[Potential genotoxic effects of cytostatics in occupationally-exposed persons]. / Potencijalni genotoksicni ucinak citostatika na profesionalno izlozeno osoblje.

The aim of the study was to determine possible mutagenic implications of occupational exposure to cytostatic agents. Twenty-one nurses handling antineoplastic drugs and a matching control group were examined. The conventional method for testing chemical mutagens, that of sister chromatid exchanges, SCE, was used. Although the results obtained in the exposed group did not significantly differ from those obtained for the controls, wide ranges of SCE values observed among the medical personnel handling cytostatic drugs confirm the suspicion of the genotoxic effect of those agents.

Chromosome aberrations induced in human lymphocytes by U-235 fission neutrons. Part II: Evaluation of the effect of the induced Na-24 activity on the chromosomal aberration yield.

Blood samples were spiked with Na-24 to study the separate effect of this nuclide on the incidence of chromosomal aberrations in neutron irradiated blood samples. A delay of 96 h was allowed before cultivation, so the results of chromosomal aberration analysis could be compared with the results obtained by direct irradiation of blood samples with U-235 fission neutrons [7]. The absorbed dose was calculated using a simple conservative model. From the results obtained we can conclude that Na-24 alone was not the reason for the difference in the incidence of chromosomal aberrations between blood samples cultivated immediately after "in vitro" irradiation by U-235 fission neutrons and samples which were cultivated after 96 h storage.

The correlation between the frequency of micronuclei and specific chromosome aberrations in human lymphocytes exposed to microwave radiation in vitro.

Human whole-blood samples were exposed to continuous microwave radiation, frequency 7.7 GHz, power density 0.5, 10 and 30 mW/cm2 for 10, 30 and 60 min. A correlation between specific chromosomal aberrations and the incidence of micronuclei after in vitro exposure was observed. In all experimental conditions, the frequency of all types of chromosomal aberrations was significantly higher than in the control samples. In the irradiated samples the presence of dicentric and ring chromosomes was established. The incidence of micronuclei was also higher in the exposed samples. The results of the structural chromosome aberration test and of the micronucleus test were comparatively analyzed. The values obtained showed a positive correlation between micronuclei and specific chromosomal aberrations (acentric fragments and dicentric chromosomes). The results of the study indicate that microwave radiation causes changes in the genome of somatic human cells and that the applied tests are equally sensitive for the detection of the genotoxicity of microwaves.

Chromosome aberrations induced in human lymphocytes by U-235 fission neutrons: I. Irradiation of human blood samples in the "dry cell" of the TRIGA Mark II nuclear reactor.

A set-up for irradiation of biological samples in the TRIGA Mark II research reactor in Ljubljana is described. Threshold activation detectors were used for characterisation of the neutron flux, and the accompanying gamma dose was measured by TLDs. Human peripheral blood samples were irradiated "in vitro" and biological effects evaluated according to the unstable chromosomal aberrations induced. Biological effects of two types of cultivation of irradiated blood samples, the first immediately after irradiation and the second after 96 h storage, were studied. A significant difference in the incidence of chromosomal aberrations between these two types of samples was obtained, while our dose-response curve fitting coefficients alpha 1 = (7.71 +/- 0.09) x 10(-2) Gy-1 (immediate cultivation) and alpha 2 = (11.03 +/- 0.08) x 10(-2) Gy-1 (96 h delayed cultivation) are in both cases lower than could be found in the literature.

The relationship between colony-forming ability, chromosome aberrations and incidence of micronuclei in V79 Chinese hamster cells exposed to microwave radiation.

Cultured V79 Chinese hamster fibroblast cells were exposed to continuous radiation, frequency 7.7 GHz, power density 0.5 mW/cm2 for 15, 30 and 60 min. The effect of microwave radiation on cell survival and on the incidence and frequency of micronuclei and structural chromosome aberrations was investigated. The decrease in the number of irradiated V79 cell colonies was related to the power density applied and to the time of exposure. In comparison with the control samples there was a significantly higher frequency of specific chromosome aberrations such as dicentric and ring chromosomes in irradiated cells. The presence of micronuclei in irradiated cells confirmed the changes that had occurred in chromosome structure. These results suggest that microwave radiation can induce damage in the structure of chromosomal DNA.

[Mutagenic and carcinogenic effects of vinyl chloride monomers in humans]. / Mutageno i karcinogeno djelovanje vinil klorid monomera na covjeka.

The use of vinyl chloride monomer in industry dates back to the late 1930s. Today the number of occupationally exposed industrial workers is estimated to be several million. After the first described cases of cancer among workers exposed to high concentrations of this gas, extensive research was initiated into its possible mechanism of action on the living organism. This paper is a review of some current knowledge about the action of vinyl chloride monomer as a substance which after metabolic activation in the organism becomes a strong carcinogenic and mutagenic agent.

Chromosomal abnormalities among nurses occupationally exposed to antineoplastic drugs.

The effect of handling antineoplastic drugs was examined in 42 nurses working in an oncology department, and the same number of nurses not exposed to antineoplastic drugs acted as controls. The exposure effect was evaluated by analysis of sister chromatid exchanges (SCE) incidence and structural chromosomal abnormalities. SCE as well as chromosomal abnormalities in the exposed group were increased (p less than 0.001 and p less than 0.01, respectively). Sign test for paired sample was used for statistical assessment.

Mutagenicity of vinyl chloride in man: comparison of chromosome aberrations with micronucleus and sister-chromatid exchange frequencies.

The mutagenic effects of vinyl chloride monomer in man were studied in the lymphocyte culture with 3 methods: the chromosome aberration assay, the micronucleus assay and the sister-chromatid exchange method. Compared with control, values obtained by these tests are increased in workers occupationally exposed to vinyl chloride. In relation to non-smokers, smokers exposed to vinyl chloride show significant increases in sister-chromatid exchange frequencies. The problem of correlating the results of the chromosome aberration assay with micronucleus and sister-chromatid exchange frequencies is discussed.

The effect of microwave radiation on the cell genome.

Cultured V79 Chinese hamster cells were exposed to continuous radiation, frequency 7.7 GHz, power density 30 mW/cm2 for 15, 30, and 60 min. The parameters investigated were the incorporation of [3H]thymidine and the frequency of chromosome aberrations. Data obtained by 2 methods (the incorporation of [3H]thymidine into DNA and autoradiography) showed that the inhibition of [3H]thymidine incorporation took place by complete prevention of DNA from entering into the S phase. The normal rate of incorporation of [3H]thymidine was recovered within 1 generation cycle of V79 cells. Mutagenic tests performed concurrently showed that even DNA macromolecules were involved in the process. In comparison with the control samples there was a higher frequency of specific chromosome lesions in cells that had been irradiated. Results discussed in this study suggest that microwave radiation causes changes in the synthesis as well as in the structure of DNA molecules.

Localization of breaks induced by vinyl chloride in the human chromosomes of lymphocytes.

A group of 67 workers occupationally exposed to VCM was examined for the presence and distribution of breaks along the chromosomal length. Breaks induced by VCM are not randomly distributed as had been expected in a normal population. According to our results there exist highly sensitive and highly resistant locations along the chromosomes to the actions of VCM. The link between the highly sensitive segments of chromosomes, fragile sites and the activation of oncogenes is discussed.